457 posters, 2 videos, 2 audios, 8 topics, 45 sessions, 401 authors, 265 institutions
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49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
March 21-23, 2024 | The Hilton Bayfront San Diego | San Diego, California
5287
INTRAOPERATIVE THORACIC EPIDURAL MANAGEMENT: SURVEY OF FACULTY ANESTHESIOLOGISTS AT A LARGE ACADEMIC HOSPITAL
Poster Presenter
Part of Topic
Safety/QA/QI Projects
Intraoperative thoracic epidural management: A survey of faculty anesthesiologists at a large academic hospital
Joseph Hodapp MD, Milap Rakholia MD, Cynthia Khoo MD, PhD
Introduction
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Expert consensus guidelines for intraoperative epidural management are lacking
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UK society study: opioid-bupivacaine combination post-operatively, intraoperative not discussed1.
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German regional anesthesiologist society: heterogeneity regarding intraoperative ropivacaine, opiate dosing, and rescue strategies2.
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Some benefits of intraoperative use include reduction in postoperative morphine consumption and improvements in early pain experience3,4.
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Our Aim: to define our institution’s current intraoperative epidural practices to help inform the development of future guidelines.
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IRB approval obtained, protocol 72517
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Single-center, quality improvement study including faculty in Stanford University Department of Anesthesiology, Perioperative and Pain Medicine
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Perioperative epidural management strategies
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Allowed respondents to select “all that apply”
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“Individualized approach” - 35/48 respondents
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Remaining respondents
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Preoperative only - 2
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Intraoperative only - 7
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Only at the end of the case - 3
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Postoperative only - 1
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Choice of Pharmacologic Agents
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Local anesthetic: Bupivacaine, Lidocaine
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Narcotic: Hydromorphone, Fentanyl
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Concentrations and doses variable
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Open-ended comments
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Interest in development of guidelines
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Primary anesthesiologist should have ultimate discretion over management